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The ER Effect as Evidence of a Deteriorating System Just How Good is Your Health Insurance?

Just How Good is Your Health Insurance?

by JEFF SHER

It’s been difficult to generate a groundswell of public opinion for real change in our deeply flawed health care system because most of the people who have medical insurance believe having insurance is equivalent to having guaranteed access to quality health care.

The insured may have empathy for the nearly 50 million uninsured in this country, but they seem to believe that the problems of the uninsured are not also their own problems.

Consider then the recently released study by a team of researchers from the Harvard Medical School. The researchers found that emergency room (ER) visits increased nearly 18 percent in the 10 years ending in 2004, while the number of hospitals operating ER’s fell 12 percent during the same decade.

The result is that patients wait longer now for treatment in emergency rooms. Waits for all types of treatments increased by 36 percent from 1997 to 2004, the researchers found. Heart attack patients waited eight minutes for treatment in 1997, but by 2004 they were waiting on average 20 minutes. One in four heart attack patients can expect to wait as long as 50 minutes or more before being treated.

This is yet another example of the deteriorating condition of our health care system. The ER problem affects patients whether they have insurance or not, no matter how "good" that insurance is.

And if you are admitted to the hospital, make sure you carefully check the bills the hospital sends you. It has been estimated by experts in the field that up to 80 percent of all hospital bills contain multiple errors. In fact, just checking the bill yourself very likely will not find all the errors.

There is a new and growing layer of the medical bureaucracy composed of billing specialists who will review your hospital bill for you and get paid either by the hour or as a percentage of the savings they generate for you by correcting the errors in the bill. Since hospital stays easily run in excess of $10,000 per day, even an insured patient’s share of a bill can mount up quickly. This is particularly true in the case of the high deductible plans that have become popular in recent years (as employers try to shift costs to employees).

Just add these issues to the growing list of obstacles to obtaining the health care you need, such as insurance company denials of coverage for treatment before the fact, denials of claims for reimbursement after the fact, difficulty in obtaining referrals to the appropriate specialists, not to mention the problems you may have obtaining insurance if you ever become unemployed or self-employed. Let’s put it this way: if you have any kind of chronic problem, or have had even a mildly serious problem in the recent past, you most likely will encounter difficulty obtaining a policy and you very likely will pay very high prices for it if you do get one. And if you have had a serious illness that has any chance of recurring or which studies show has even the slightest chance of rendering you more susceptible to other serious complications in the future (even the distant future), don’t expect to find insurance at all.

Almost everyone knows someone else who has encountered difficulties in obtaining the medical care they need, yet we persist in believing we have the "good" coverage.

Perhaps people who think like this should have their head examined. Except most likely they will find that kind of treatment is not covered by their insurance.

JEFF SHER lives in the Bay Area. He can be reached at: jeffsher@sbcglobal.net